3. Learn how to make decisions

As the substitute decision-maker (SDM), you must make your decisions based on:

• the person's wishes, and
• what's in their best interests.

The person's wishes

You first need to think about what the person's wishes for their health care and treatment were when they were mentally capable.

Someone who's mentally capable and 16 years of age or older can put their wishes in writing or tell someone about them.

They can put their wishes in:

• a Power of Attorney for Personal Care,
• an Advance Care Directive, or
• a note to you, their family, or other people in their life. 

Or they may talk to you or someone else about what they would want.

If you do not know what the person's wishes were when they were mentally capable, ask their family members or friends.

Once you know what wishes they made, you must:

• consider them when making decisions, and
• follow them as much as you can, even if you do not agree with them. 

Newer wishes

If someone makes new wishes, these are the ones to follow. But only if the person makes them when they're mentally capable. The law says that wishes are not valid if the person makes them when they're not mentally capable.

People younger than 16

You do not have to follow the person's wishes if they're younger than 16.

But you should still think about their wishes if they told you or someone else about them when they were able to:

• understand the information about the treatment, and
• say what they want.

Best interests

You may not know what the person's wishes are. Or it may be impossible to follow them. For example, when the person was mentally capable, they told you that if they became quite ill, they did not want a feeding tube. Now, their doctor says they need one and there are no other options. You must decide what's in the person's best interests.

Thinking about best interests

The Health Care Consent Act lists what you need to think about when deciding about the person’s best interests.

You must think about whether getting the treatment is likely to:

• improve the person's condition or well-being or stop it from getting worse, or
• slow down how fast the person's condition or well-being is getting worse.

You must also think about:

• what's likely to happen if the person does not get the treatment,
• whether the treatment is more likely to help the person than harm them, and 
• if there's another treatment that would be just as helpful but not as hard on the person.

Talk to any other SDMs

You may not be the only SDM. The person may have chosen another SDM to act with you.

Or someone who ranks the same as you on the list of who can be an SDM might want to also be an SDM for the person. The list is in the Answer under Who can be an SDM.